Abstract
Considering the worsening opioid epidemic, complicated infective
endocarditis (IE) secondary to intravenous drug use (IVDU) that fails
medical management is increasingly common. We present a 31-year-old
patient post tricuspid valve replacement who relapsed with recurrent IE
and secondary complications of severe tricuspid stenosis and
regurgitation, ventricular septal defect (VSD), pulmonary emboli,
right-sided heart failure with severe hepatic congestion, and
cardiogenic shock. Despite maximal medical management, the patient
remained in septic and cardiogenic shock with a potential disposition to
hospice care. Upon consulting cardiothoracic surgery, she underwent a
first-stage valvectomy with Extracorporeal Membrane Oxygenation (ECMO)
as a bridge to definitive treatment. After clearance of infection, she
underwent a second-stage valve replacement, VSD repair, and final ECMO
decannulation. Our case alludes to ECMO as a potential bridge for
patients with complicated infective endocarditis who fail medical
management and are high-risk candidates for immediate definitive
surgical management.